The thing about ADHD (or as it’s called more casually in the public – ADD), is that it’s pretty hard to challenge once the “diagnosis” has been given.
There are no legitimate tests that I know of for ADD. Physicians primarily rely on rating scales, like the Vanderbilt, as a primary source for making a determination.
These scales involve opinions, not facts, usually from the parent on a set of behaviors that typically cluster on what is thought to be ADHD/ADD.
Here are a few of the items from the Vanderbilt Scales that usually will ring the “ADHD/ADD bell” inevitably leading to a diagnosis and recommendation to put the child on medication:
“Has difficulty sustaining attention.”
“Is easily distracted by extraneous stimuli.”
“Loses things necessary for tasks and activities.”
So, let’s line up a few hundred 8 or 9 year old boys and ask their mothers (the fathers don’t usually know) how they would rate their kid on these items. I would predict about 70% of the boys in that age range would be rated somewhat high on variables such as these.
What then? Does this mean that most of these boys have a neurodevelopmental disorder and should be put on stimulant medication?
I recently read an article that referred to the marked rise (16% increase over the last decade and a 41 percent increase from the previous decade) in diagnosis of ADHD. Boys, in particular, showed a significant increase in percentage being diagnosed.
We’ve gotten so casual with the diagnoses and the inevitable medical prescriptions.
People will think I am anti-medication. I am not.
But, I am against the use of rating scales as the primary determinant of the “diagnosis.” Rating scales are very helpful when used as part of a larger assessment that attempts to take many factors into consideration. In fact, in all of the assessments I conduct rating scales are an important part of the evaluation.
However, it’s also my expectation that about 90% of the kids who land in my office are going to show high on these “ADHD/ADD’ variables.
Does that mean they should all be on medication?
Without trying very hard I could list 20 reasons that may be contributing to a child‘s inconsistent focusing or variable effort that are not related to an inherent neurobiological disability. That is, kids have a lot of stuff (not scientific I know) that can help explain their “difficulty sustaining attention.” (In a future blog we will list some of the “stuff” that masquerades as ADHD/ADD.)
There is no definite “X-Ray” of ADHD/ADD. Before placing a child on medication, try and take the big picture and consider what else may be working..
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